OBJECTIVE: To estimate the associations between autism spectrum disorder (ASD) diagnoses and service use, caregiver time, and cost outcomes. METHODS: We used national data from the Medical Expenditure Panel Survey linked to the National Health Interview Survey and a study-specific survey to estimate the annual utilization and costs for health care, school, ASD-related therapy, family-coordinated services, as well as caregiver time in children aged 3 to 17 years, with and without parent-reported ASD. Regression analyses estimated the association between ASD diagnosis and cost, controlling for child gender, age, race/ethnicity, insurance status, household income, country region and urban/rural classification, and non–ASD-related illnesses. RESULTS: Children with parent-reported ASD had higher levels of health care office visits and prescription drug use compared with children without ASD (P < .05). A greater proportion of children in the ASD group used special educational services (76% vs 7% in the control group, P < .05). After adjusting for child demographic characteristics and non–ASD-associated illnesses, ASD was associated with $3020 (95% confidence interval [CI]: $1017–$4259) higher health care costs and $14 061 (95% CI: $4390–$24 302) higher aggregate non–health care costs, including $8610 (95% CI: $6595–$10 421) higher school costs. In adjusted analyses, parents who reported that their child had ASD did not have significantly higher out-of-pocket costs or spend more time on caregiving activities compared with control parents. CONCLUSIONS: The economic burden associated with ASD is substantial and can be measured across multiple sectors of our society. Previous analyses that focused on health care underestimated this economic burden, particularly for school systems.

The economic burden of childhood autism spectrum disorders

Breast cancer remains an important public health problem. This study aimed to investigate about female knowledge of breast cancer and self-reported practice of breast self-examination in Iran. This was a population-based survey carried out in Tehran, Iran. Data were collected via a structured questionnaire containing 15 questions on demographic status, history of personal and family breast problems, subjective knowledge about breast cancer covering its symptoms, the screening methods and practice of breast self-examination (BSE). A trained female nurse interviewed each respondent. Analysis included descriptive statistics and the Chi-squared test where necessary. A total of 1402 women were interviewed. The mean age of respondents was 43.4 (SD = 14.4) years; most were married (85%), and without any personal (94%) and family history (90%) of breast problems. It was found that 64% of the respondents were familiar with breast cancer and 61% (n = 851) believed that 'the disease is relatively common among women in Iran'. Most women (44%) perceived a painless mass as a breast cancer symptom. Overall, 61% of the respondents stated that they knew about breast cancer screening programs and most indicated that electronic media (television 34% and radio 14%) were their source of information. Only 17% of women said that 'they were conducting regular breast self-examination'. The main reason for women not doing breast self-examination was due to the fact that they did not know how to do it (64%). The findings indicated that performing breast self-examination is significantly related to: age, marital status, education, knowledge of breast cancer and knowledge about breast cancer screening programs (p < 0.05), but not to personal (P = 0.2) and family (P = 0.7) history of breast problems. This descriptive study provides useful information that could be utilized by both researchers and those involved in public health programmes. The findings indicated that the women awareness of breast cancer warning signs (painless lump, retraction of nipple, and bloody discharge) and effective screening methods i.e. clinical examination, and mammography were very inadequate. Thus, health education programmes to rectify the lack of women awareness is urgently needed. Indeed the focus of primary health care providers should be to raise awareness about breast care among women and to encourage them to report any unusual changes in their breasts to their family or care physicians.

/pdf/breast-cancer-in-iran-need-for-greater-women-awareness-of-2ya7jasqxp.pdf

Breast cancer in Iran: need for greater women awareness of warning signs and effective screening methods

Breast cancer appears to be a disease of both the developing and developed worlds. Among Turkish women, breast cancer is the second leading cause of cancer-related deaths. The aims of this cross-sectional study were to determine levels of knowledge about breast cancer and to evaluate health beliefs concerning the model that promotes breast self- examination (BSE) and mammography in a group of women aged 20–64 in a rural area of western Turkey. 244 women were recruited by means of cluster sampling in this study. The questionnaire consisted of sociodemographic variables, a risk factors and signs of breast cancer form and the adapted version of Champion's Health Belief Model Scale (CHBMS). Bivariate correlation analysis, Chi square test, Mann-Whitney U test and logistic regression analysis were performed throughout the data analysis. The mean age of the women was 37.7 ± 13.7. 49.2% of women were primary school graduates, 67.6% were married. Although 76.6% of the women in this study reported that they had heard or read about breast cancer, our study revealed that only 56.1% of them had sufficient knowledge of breast cancer, half of whom had acquired the information from health professionals. Level of breast cancer knowledge was the only variable significantly associated with the BSE and mammography practice (p = 0.011, p = 0.007). BSE performers among the study group were more likely to be women who exhibited higher confidence and perceived greater benefits from BSE practice, and those who perceived fewer barriers to BSE performance and possessed knowledge of breast cancer. By using the CHBMS constructs for assessment, primary health care providers can more easily understand the beliefs that influence women's BSE and mammography practice.

/pdf/the-knowledge-and-attitudes-of-breast-self-examination-and-3ed7pyb457.pdf

The knowledge and attitudes of breast self-examination and mammography in a group of women in a rural area in western Turkey.

Factors associated with breast cancer screening behaviours in a sample of Turkish women: A questionnaire survey

guvenc g., akyuz a. & acikel c.h. (2011) Health Belief Model Scale for Cervical Cancer and Pap Smear Test: psychometric testing. Journal of Advanced Nursing 67(2), 428–437.

Abstract
Aim.  This study is a report of the development and psychometric testing of the Health Belief Model Scale for Cervical Cancer and the Pap Smear Test.

Background.  While the Champion Health Belief Model scales have been tested extensively for breast cancer and screening for this, evaluation of these scales in explaining the beliefs of women with regard to cervical cancer and the Pap Smear Test has only received limited attention.

Methods.  This methodological research was carried out in Turkey in 2007. The data were collected with 237 randomly selected women who met the criteria for inclusion and agreed to participate in this study. The Champion Health Belief Model scales were translated into Turkish, adapted for cervical cancer, validated by professional experts, translated back into English and pilot-tested.

Findings.  Factor analysis yielded five factors: Pap smear benefits and health motivation, Pap smear barriers, seriousness, susceptibility and health motivation. Cronbach’s alpha reliability coefficients for the five subscales ranged from 0·62 to 0·86, and test–retest reliability coefficients ranged from 0·79 to 0·87 for the subscales.

Conclusion.  The Health Belief Model Scale for Cervical Cancer and the Pap Smear Test was found to be a valid and reliable tool in assessing the women’s health beliefs. Understanding the beliefs of women in respect of cervical cancer and the Pap Smear Test will help healthcare professionals to develop more effective cervical cancer screening programmes.

Health Belief Model Scale for Cervical Cancer and Pap Smear Test: psychometric testing

Breast cancer is the second leading cause of cancer deaths in Turkish women, and the use of breast self-examination (BSE) and mammography remains low in Turkey. Therefore, we need to identify the beliefs, influencing BSE and mammography, and a valid and reliable tool to measure constructs. The Champion's health belief model scale (CHBMS) is a valid and reliable tool to measure beliefs about breast cancer, BSE, and mammography in an English culture. The purpose of this study was to assess the psychometric characteristics of a Turkish version of the CHBMS related to breast cancer, BSE, and mammography. A convenience sample of 656 women was recruited from 3 health centers and 2 maternal and child health centers in Istanbul. The CHBMS was translated to Turkish, validated by professional judges, back translated, and tested. Factor analysis yielded 7 factors for BSE: confidence, seriousness, barriers-BSE, health motivation 1 and 2, susceptibility, and benefits-BSE. For mammography scale, 6 factors were identified: seriousness, benefits-mammography, barriers-mammography, health motivation 1 and 2, and susceptibility. All items on each factor were from the same construct. Cronbach alpha reliability coefficients ranged from.75 to.87 for the subscales. The Turkish version of the CHBMS showed adequate reliability and validity for use in Turkish women. It could easily be used to evaluate the health beliefs about breast cancer, BSE, and mammography. Further refinement is required to study Turkish women's health beliefs and breast cancer screening behaviors in various settings.

Reliability and validity of the breast cancer screening belief scale among Turkish women.

Purpose/objectives To examine health beliefs and sociodemographic and breast cancer-related variables influencing breast self-examination (BSE) practice. Design Descriptive, cross-sectional. Setting Two vocational training centers in Istanbul, Turkey. Sample 438 women were selected using a convenience sampling method. Participants had not had breast cancer and were not currently pregnant or breast-feeding. The mean age of participants was 33.51 years (range = 18-67). Methods Willing participants were asked to complete a self-administered questionnaire and the Turkish version of Champion's Health Belief Model Scale. The sample was categorized into two groups: performers (i.e., women who performed BSE at least occasionally) and non-performers (i.e., women who had never performed BSE). Main research variables Perceived susceptibility to and seriousness of breast cancer, perceived benefits of and barriers to BSE, confidence in the ability to perform BSE, health motivation, and frequency of BSE practice. Findings Significant differences between performers and non-performers correlated to age, marital status, health insurance, regular gynecologic visits, and education about breast cancer and BSE. The mean scores of perceived benefits and confidence were noticeably higher in performers. Stepwise logistic regression analysis yielded three significant predictor variables. Conclusions Women who had more confidence in their ability to perform BSE, had health insurance, and were informed about breast cancer were more likely to practice BSE. Implications for nursing Women in Turkey are at great risk for advanced breast cancer and metastatic spread because of their lack of knowledge. Nurses must provide information on breast cancer etiology, risks, prevention, and detection. To promote BSE practice among Turkish women, tailored health education and health promotion programs should be developed based on a specific understanding of women's health beliefs.

https://onf.ons.org/sites/default/files/XL822Q3357237466_first.pdf

Health beliefs related to breast self-examination in a sample of Turkish women.

The effectiveness of a nurse-delivered breast health promotion program on breast cancer screening behaviours in non-adherent Turkish women: A randomized controlled trial.

This article is about the pilot test of a Turkish version of the Exercise of Self-Care Agency Scale (ESCA) using a randomized convenience sample of 119 bilingual Turkish adolescents. The instrument was translated into Turkish, back translated, and pilot tested to linguistic equivalence. Bilingual participants were randomly assigned to four groups. Each participant was administered both the English and the Turkish versions of the scale but in different order at 5-week intervals. The results show that the Turkish version of the ESCA was linguistically equal to the English form. Test-retest correlations were acceptably high (r = .80 to .90). Internal consistency of the total scale of the ESCA was adequate, with an alpha coefficient of .89 for the Turkish version and .88 for the English version. Further research in the development of this translated form would need to demonstrate its applicability and generalizability to monolingual Turkish adolescents.

Nursen O. Nahcivan

Papers

Factors associated with breast cancer screening behaviours in a sample of Turkish women: A questionnaire survey

Reliability and validity of the breast cancer screening belief scale among Turkish women.

Health beliefs related to breast self-examination in a sample of Turkish women.

The effectiveness of a nurse-delivered breast health promotion program on breast cancer screening behaviours in non-adherent Turkish women: A randomized controlled trial.

A Turkish language equivalence of the Exercise of Self-Care Agency Scale.